Tooth extraction under anesthesia: the dangers of sedation

If you, like 98% of the world’s population, are afraid of visits to the dentist, tooth extraction under anesthesia is an easy way to perform the procedure. You fall asleep, wake up, and the tooth is gone. But is it that easy, and most importantly, is it safe?

There are different degrees of medically controlled consciousness:

Mild (sometimes called superficial). The patient is aware of what is happening, makes contact, follows instructions. Only coordination and reactions are slowed down, and the patient himself experiences a sense of relaxation.
Medium. Inhibition of the nervous system is deeper, but consciousness and reflexes are preserved, the patient responds to specific stimuli.
Deep. Depression of CNS functions is increasing, the patient reacts only to strong stimuli. At the same time, defense reflexes are preserved, but respiratory monitoring is required.
General anesthesia. Complete unconsciousness, no reaction to stimuli, respiratory support is needed, monitoring of all body functions. At this stage, reflexes are inoperative, pain receptors are shut down.

The first 3 states are sedation. The fourth stage is anesthesia.

How is sedation different from anesthesia?

Sedation is a depression (suppression) of consciousness to the level of relaxation. All defense reflexes are preserved, for example, a blood clot entering the airway will cause a coughing fit. Sedation reduces the level of reactions, but does not block pain receptors, for this purpose local anesthesia is used.

Anesthesia causes complete unconsciousness, so it requires monitoring of all vital functions. General anesthesia shuts down pain receptors, no additional anesthesia is needed.

The term “sedation” has not caught on in common usage and often simple relaxation is also referred to as anesthesia. It is worth remembering that tooth extraction under general anesthesia is rarely used, mainly in hospitals. This requires a specially equipped operating room, all necessary for resuscitation, and the procedure should be carried out by a qualified anesthesiologist.

Therefore, if you are offered to remove a tooth under anesthesia, clarify what is meant: anesthesia or sedation.

How tooth extraction under sedation takes place

The dentist’s task is to save the tooth using all possible methods. Therefore, difficult cases are assigned for extraction: wisdom teeth, retined (not erupted), dystopian (misaligned) teeth, units with intertwined, twisted roots, with a destroyed crown part.

Manipulation begins with diagnosis, which consists of examination, with the use of instruments, X-rays, collection of anamnesis.

Before the procedure, it is necessary to take an electrocardiogram and take a general blood test, possible tests to detect allergies.

In adults, the sedative drug is most often administered intravenously. The dose is adjusted depending on age and body weight.

The anesthesiologist administers the drug through a catheter, the patient falls into sleep. The surgeon performs the removal. After the operation is completed, the drug is stopped and the patient wakes up within 10 minutes. For some time he is under the supervision of the doctor.

In pediatric dentistry, the inhalation method is more often used, it is also used for adults, but less often.

Recommendations after the removal of wisdom teeth under anesthesia or other complex extractions are the same as after a normal operation:

Do not eat or drink for 2 hours;
avoid hot, cold, spicy, acidic foods on the day of surgery;
postpone physical activity for a couple of days;
do not go to baths and saunas;
apply ice to the surgical site;
do not warm.

After the use of anesthesia or sedation, it is recommended not to drive a car and avoid activities that require high concentration.

Is the removal of wisdom teeth under sedation and anesthesia dangerous?

Any surgical intervention is associated with certain risks. Alas, with the use of anesthesia, these risks increase. The fact is that under anesthesia, consciousness is completely disconnected and the success of treatment depends on:

The experience and qualifications of the anesthesiologist;
the equipment of the operating room;
technical base for resuscitation.

What can go wrong

The vast majority of complications are caused by a doctor’s error. Incompetence of the anesthesiologist entails:

Problems with the respiratory system. Mucus, blood clots can get into the airways and block them, as protective reflexes are depressed during general anesthesia.
Problems with the cardiovascular system. Incorrect dosage causes different reactions: slowing or speeding up the rhythm of heartbeats, falling or rising blood pressure.

Exit from anesthesia can be accompanied by nausea, vomiting, inadequate behavior. General anesthesia – a serious shake for the body, do not consider it harmless.

With sedation, the risks are less, but they are also there. These are the same disorders of breathing and hemodynamic processes (problems with blood pressure and heart rate).

When it is worth removing a wisdom tooth under general anesthesia

Absolute intolerance to local anesthetics is the main indication for such an extraction. With stomophobia, anxiety, increased gag reflex, sedation is preferable for wisdom tooth extraction.

The doctor should be guided by a combination of all factors when choosing a method of treatment. Very rarely general anesthesia outweighs the difficulties of surgery without it.

How to survive tooth extraction without sedation

The main thing is the mindset. There are non-medication methods that provide a certain level of relaxation. A friendly atmosphere in dentistry, sincere interest of the doctor, preliminary conversation, light music, pleasant décor, all this sets our nervous system on a calm mood. Before the operation you can drink soothing decoctions and infusions. Valerian, motherwort have a mild sedative effect.

Other factors include:

The choice of local anesthesia. Modern analgesics act quickly and purposefully. Even with complex removals, the patient does not feel pain.
The qualifications of the surgeon. An experienced doctor acts quickly and clearly, instilling confidence in the patient and not giving him time to be scared properly.
Clinic equipment. New instruments and innovative technologies, such as piezosurgical techniques, make tooth extraction much easier for the doctor and for the patient.

^{ROOTT Clinic patient’s testimonial about wisdom tooth extraction under local anesthesia}

Anesthesia in dentistry is of a different nature, and a different method is chosen for each specific case. Do not think that anesthesia or sedation is the solution to all problems. Any treatment requires a clear rationale.